Transition to retirement and risk of cardiovascular disease: Prospective analysis of the US health and retirement study
Introduction
Americans now spend more years in retirement than ever before. A major wave of retirement started in 2011, when the first Baby Boomers (born 1946–1964) began to turn 65 (He, Sengupta, Velkoff, & DeBarros, 2005). By 2050, the older population is projected to number 86.7 million. The average age of retirement, which has been declining since the 1950s, has once again been falling again since 1990 after having leveled off during the mid-1970s through 1980s (Gendell, 2001). With the first wave of the Baby Boomers' retirement and spiraling health care costs for the elderly, the question of how retirement affects health is of vital importance.
Theoretically, it has been argued that retirement might have either good or bad effects on cardiovascular health (Kasl & Jones, 2000). Retirement is a lifecourse transition involving environmental changes that reshape health behaviors, social interactions, and psychosocial stressors. It is also a subjective developmental and social psychological change in identity and preferences (Dannefer, 1984). However, there is little consensus about the impact of the retirement transition on health outcomes. Existing evidence is conflicting, and reverse causality is difficult to rule out because of unobserved selection into retirement.
Empirical findings on the health risks of retirement have been inconsistent, variously reporting harmful, beneficial or no effects. Some early studies suggested that being retired had no deleterious effects on either physical or psychological health (Kasl, 1980; Minkler, 1981). However, those studies often ignored the complexity of the retirement transition, including issues of timing, previous health, and quality of the job (McGoldrick & Cooper, 1988). More current literature reports contradictory findings. A recent study in France showed that retirement was associated with improved self-perceived health for those in poor work environments and those with health complaints before retirement (Westerlund et al., 2009). Another recent Swedish study used recorded purchases of anti-depressant medication to measure mental health; they found that retirement was associated with decreased anti-depressant usage (Oksanen et al., 2011). Others found adverse associations, reporting increased musculoskeletal and CVD prevalence among retired Finnish men (Tuomi, Järvinen, Eskelinen, Ilmarinen, & Klockars, 1991), and significantly elevated risk of severe cardiovascular disease or cancer onset associated with retirement in England (Behncke, 2011). There are also studies reporting no effect on physical or mental health. One study found that retirement was associated with a reduction in mental and physical fatigue and depressive symptoms, particularly among people with chronic diseases, but retirement did not change the risk of major chronic disease onset (stroke, MI and coronary heart disease) (Westerlund et al., 2010). These mixed results may be partially attributable to incomplete adjustment for differential selection into retirement, i.e., lack of comparability between retirees and those who continue to work at similar ages (Miah & Wilcox-Gök, 2007).
We investigated factors that may modify the effect of retirement on cardiovascular health, specifically risk of first stroke and myocardial infarction (MI). We hypothesized that higher individual- and family-level SES modifies the association between retirement and cardiovascular health. In this paper, we aim to address both reverse causation and effect modification by exploiting the extensive set of measures available in a nationally representative sample of Americans transitioning into retirement.
Section snippets
Methods
Data were drawn from the nationally representative, longitudinal Health and Retirement Study (HRS), described in detail elsewhere (Juster & Suzman, 1995). Our follow-up began in 1998, the earliest year when the sample was representative of all birth cohorts up to 1947. Biennial interviews (or proxy interviews for decedent participants) were conducted through 2008, by telephone or in person. We included HRS participants born 1900 to 1947 who participated in the 1998 wave and follow them to 2008.
Results
There were 665 self- or proxy-reports of first incidence of stroke or MI by 2008. Adjusted for age and sex, on average over 10 years of follow-up time, retirement was associated with elevated odds of CVD onset (OR = 1.62, 95% CI: 1.20, 2.18) compared to the full-time working population (Table 2). In models adjusted for childhood SES, adult SES, family-level SES, behavioral risk factors and co-morbidities, retirement was still associated with significantly increased odds of CVD onset (OR = 1.40,
Discussion
In this large, nationally representative sample of Americans aged ≥50 years, retirement was associated with an elevated risk of cardiovascular disease (stroke or MI) compared to full-time employment. This elevated risk appeared to be more marked during the first year after retirement, although estimates were not significantly different from those for the second year and beyond. There was no evidence of a significant interaction by gender or SES in the association between retirement and CVD risk.
Acknowledgments
The authors gratefully acknowledge financial support from the following funding sources: JRM is supported by the National Research Service Award (NRSA) training grant (T32-HL098048-01); MA is supported by a grant from the European Research Council (263684) and a Eurfellowship from the Erasmus University; MMG is supported by American Heart Association (10SDG2640243).
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